Coronary Artery Bypass Grafting in Cancer Patients: Prevalence and Outcomes in the United States.

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From: Mayo Clinic Proceedings(Vol. 95, Issue 9)
Publisher: Elsevier, Inc.
Document Type: Article
Length: 4,548 words
Lexile Measure: 1720L

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Abstract

Objective: To characterize the contemporary efficacy and utilization patterns of coronary artery bypass grafting (CABG) in specific cancer types.

Methods: We leveraged the data from the National Inpatient Sample and plotted trends of utilization and outcomes of isolated CABG (with no other additional surgeries during the same hospitalization) procedures from January 1, 2003, through September 1, 2015. Propensity score matching was used to assess for potential differences in outcomes by type of cancer status among contemporary (2012-2015) patients.

Results: Overall, the utilization of CABG decreased over time (250,677 in 2003 vs 134,534 in 2015, PC.001). However, the proportion of those with comorbid cancer increased (7.0% vs 12.6%, PC.001). Over time, in-hospital mortality associated with CABG use in cancer remained unchanged (.9% vs 1.0%, P=.72); yet, cancer patients saw an increase in associated major bleeding (4.5% vs 15.3%, PC.001) and rate of stroke (.9% vs 1.5%, P < .001) over time. In-hospital cost-of-care associated with CABG-use in cancer also increased over time ($29,963 vs $33,636, P < .001). When stratified by cancer types, in-hospital mortality was not higher in breast, lung, prostate, colon cancer, or lymphoma versus non-cancer CABG patients (all P>.05). However, there was a significantly higher prevalence of major bleeding but not stroke in patients with breast and prostate cancer only compared with non-cancer CABG patients (PC.01). Discharge dispositions were not found to be different between cancer subgroups and non-cancer patients (P>.05), except for breast cancer patients who had lower home care, but higher skilled care disposition (P < .001).

Conclusion: Among those undergoing CABG, the prevalence of comorbid cancer has steadily increased. Outside of major bleeding, these patients appear to share similar outcomes to those without cancer indicating that CABG utilization should be not be declined in cancer patients when otherwise indicated. Further research into the factors underlying the decision to pursue CABG in specific cancer sub-groups is needed.

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Coronary artery disease (CAD) remains the leading cause of cardiovascular disease (CVD) death, accounting for nearly 50% of CVD deaths. (1) However, recent data have suggested a significant shift in the representation of those with CAD, with a higher prevalence of patients with a concurrent cancer diagnosis, a condition for which a new generation of novel immune-based and targeted therapies have altered and dramatically prolonged life-expectancies. Despite these improved outcomes, cancer patients face nearly twice the risk of CAD, including acute coronary syndromes, within months of a cancer diagnosis. (2) This increased risk is even more compounded by recent advances in cancer treating therapies, including radiation treatment, which have dramatically prolonged life expectancies in cancer, but are often associated with an increased CVD risk. (1) Many of these patients present with increasingly complex CAD and challenging clinical scenarios. Although available data suggest a potential uptake in the use of percutaneous coronary interventions (PCIs) in this population, the proportional use of coronary artery bypass graft (CABG) remains largely unknown. (1)

Available evidence suggests that cancer patients undergoing PCI have increased complications, such as in-hospital mortality and bleeding. This...

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Gale Document Number: GALE|A636516038